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BUILDING PERMIT APPLICATkA <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) q510 PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 9W 7th Ave SE PARCEL#: <br /> crry Everett STATE WA zip 98208 <br /> SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):Chelsea Heights Lot 01 <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Chelsea Heights Lot No.:47 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Pacific Ridge Homes-DR Horton LLC <br /> OWNER MAILING ADDRESS: STREET 17921 Bothell Everett Hwy Ste 100 <br /> crry Bothell STATE WA zlp 98012 <br /> OWNER PHONE:425.939.1164 1OWNER EMAIL: RLCIancy@drhorton.com <br /> CONTRACTOR COMPANY NAME:Pacific Ridge Homes <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):PAC IFICRD851J13 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5(v f t93 <br /> CONTRACTOR ADDRESS: STREET17921 Bothell Everett Hwy Ste 100 <br /> CITY Bothell STATE WA ZIP 98012 <br /> CONTRACTOR PHONEA25.939.1164 1CONTRACTOR EMAIL:RLCIancy@p drhorton.COm <br /> PRIMARY CONTACT: ❑� OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425.939.1 164 <br /> Rhonda Clancy CONTACT EMAIL:RLCiancy@drhorton.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$43 4 z r 3(O ASSOCIATED LAND USE PROJECT#(if applicable):RB2306-005 <br /> (Valuation shall include the prevaiing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:NSA <br /> PROPOSED USE OF BUILDING:New Single family residence <br /> HEAT SOURCE: ❑Gas ©Electric ❑Other <br /> BUILDING TYPE: ©SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑✓New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ©Olher:RB2306-001 <br /> DESCRIPTION OF WORK:New single family home using approved Registered Basic RB2306-005 (Lennon AB) <br /> ACKNOWLEDGEMENT I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance./am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# 5 1 — L ` U- I <br /> A&�-� 02.08.24 ` V <br /> Owner/Authorized Agent Signature Date (Revised 412112022) <br />